Surgical instruments and end effectors therefor

ABSTRACT

An end effector includes a first jaw and a second jaw, the first jaw movable relative to the second jaw to transition the end effector between an open configuration and an approximated configuration to clamp tissue therebetween. The end effector may also include a camming assembly movable along a curved path. The camming assembly includes a first camming member which includes a first distal camming portion, a first proximal camming portion, and a first flexible portion extending between the first distal camming portion and the first proximal camming portion. The camming assembly includes a second camming member and a connector at least partially disposed between the first camming member and the second camming member, wherein the camming assembly is movable relative to the end effector to exert a camming force against the first jaw and the second jaw to transition the end effector to the approximated configuration.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application claiming priority under35 U.S.C. §120 to U.S. patent application Ser. No. 14/171,035, entitledSURGICAL INSTRUMENTS AND END EFFECTORS THEREFOR, filed Feb. 3, 2014, nowU.S. Patent Application Publication No. 2014/0148806, which is acontinuation application claiming priority under 35 U.S.C. §120 to U.S.patent application Ser. No. 12/781,243, entitled SURGICAL INSTRUMENTSAND END EFFECTORS THEREFOR, filed May 17, 2010, which issued on Apr. 1,2014 as U.S. Pat. No. 8,685,020, the entire disclosures of which arehereby incorporated by reference herein.

BACKGROUND

Various embodiments are directed to surgical instruments that may beused, for example, in open and minimally invasive surgical environments.

In various circumstances, a surgical instrument can be configured toapply energy to tissue in order to treat and/or destroy the tissue. Incertain circumstances, a surgical instrument can comprise one or moreelectrodes which can be positioned against and/or positioned relative tothe tissue such that electrical current can flow from one electrode,through the tissue, and to the other electrode. The surgical instrumentcan comprise an electrical input, a supply conductor electricallycoupled with the electrodes, and/or a return conductor which can beconfigured to allow current to flow from the electrical input, throughthe supply conductor, through the electrodes and the tissue, and thenthrough the return conductor to an electrical output, for example.Alternatively, the surgical instrument can comprise an electrical input,a supply conductor electrically coupled with the electrodes, and/or areturn conductor which can be configured to allow current to flow fromthe electrical input, through the supply conductor, through the activeelectrode and the tissue, and to the return electrode through the returnconductor to an electrical output. In various circumstances, heat can begenerated by the current flowing through the tissue, wherein the heatcan cause one or more hemostatic seals to form within the tissue and/orbetween tissues. Such embodiments may be particularly useful for sealingblood vessels, for example. The surgical instrument can also comprise acutting member that can be moved relative to the tissue and theelectrodes in order to transect the tissue.

By way of example, energy applied by a surgical instrument may be in theform of radio frequency (“RF”) energy. RF energy is a form of electricalenergy that may be in the frequency range of 300 kilohertz (kHz) to 1megahertz (MHz). In application, RF surgical instruments transmit lowfrequency radio waves through electrodes, which cause ionic agitation,or friction, in effect resistive heating, increasing the temperature ofthe tissue. Since a sharp boundary is created between the affectedtissue and that surrounding it, surgeons can operate with a high levelof precision and control, without much sacrifice to the adjacent normaltissue. The low operating temperatures of RF energy enables surgeons toremove, shrink or sculpt soft tissue while simultaneously sealing bloodvessels. RF energy works particularly well on connective tissue, whichis primarily comprised of collagen and shrinks when contacted by heat.

Further, in various open and laparoscopic surgeries, it is necessary tocoagulate, seal or fuse tissues. One preferred means of tissue-sealingrelies upon the application of electrical energy to captured tissue tocause thermal effects therein for sealing purposes. Various mono-polarand bi-polar RF jaw structures have been developed for such purposes. Ingeneral, the delivery of RF energy to a captured tissue volume elevatesthe tissue temperature and thereby at least partially denatures proteinsin the tissue. Such proteins, including collagen, are denatured into apertinacious amalgam that intermixes and fuses together as the proteinsdenature or form new cross links. As the treated region heals over time,this biological “weld” is reabsorbed by the body's wound healingprocess.

In a typical arrangement of a bi-polar radiofrequency (RF) jaw, the faceof each jaw comprises an electrode. RF current flows across the capturedtissue between electrodes in opposing jaws. Most commercially availablebi-polar jaws provide a low tissue strength weld immediatelypost-treatment.

During some procedures, it is often necessary to access target tissuethat requires severe manipulation of the end effector. In suchapplications, it would be desirable to have a curved and/orarticulatable end effector arrangement to improve access andvisualization of the surgical area by the surgeon.

The foregoing discussion is intended only to illustrate various aspectsof the related art in the field of the invention at the time, and shouldnot be taken as a disavowal of claim scope.

SUMMARY

In accordance with various non-limiting embodiments, there is providedan electrosurgical instrument that includes an elongate shaft that has adistal end and defines a first longitudinal axis. An end effector may beoperably coupled to the distal end of the elongate shaft. The endeffector may comprise a first jaw that has a first elongate portion anda first curved distal end. The end effector may further include a secondjaw that has a second elongate portion and a second curved distal end.The first elongate portion of the first jaw may be movably coupled tothe second elongate portion of the second jaw. The first and secondelongate portions may define a second axis that is offset from the firstlongitudinal axis.

In accordance with various other non-limiting embodiments of the presentinvention, there is provided a surgical instrument that may include anelongate shaft that defines a longitudinal axis. The surgical instrumentmay further include an end effector that is operably supported at adistal end of the elongate shaft. The end effector may comprise a firstjaw that has a first proximal portion that is coaxially aligned with theelongate shaft. The end effector may include a second jaw that has asecond proximal portion that is coaxially aligned with the elongateshaft. The first and second jaws may be selectively movable between openand closed positions. The instrument may further include an actuationsystem that interfaces with the first and second jaws for selectivelymoving at least one other portion of the first jaw and at least oneother portion of the second jaw out of axial alignment with the elongateshaft.

In accordance with still other various non-limiting embodiments of thepresent invention, there is provided an electrosurgical instrument thatmay include a first jaw that has a first tapered distal end portion. Theinstrument may further include a second jaw that has a second tapereddistal end portion wherein the first and second jaws are selectivelymovable between open and closed positions and wherein the first taperedend and the second tapered end converge to form a substantially conicalend effector tip when the first and second jaws are in a closedposition. The instrument may further include an axially translatablereciprocal member that is supported for axial reciprocal travel withinthe first and second jaws. The axially translatable reciprocal membermay comprise a first flange that is configured for axial movableengagement with said first jaw. The first flange may have a firstdistal-most edge. The instrument may further include a second flangethat is coupled to the first flange by a central web portion. The secondflange may be configured for axial movable engagement with the secondjaw. The second flange may further have a second distal-most edge thatprotrudes distally beyond said first distal-most edge of the firstflange. A cutting edge may be formed on a distal end of the central webthat extends from the second distal-most edge to the first distal-mostedge.

In accordance with other various non-limiting embodiments of the presentinvention, there is provided a surgical instrument that comprises ahandle and an elongate shaft that is coupled thereto such that a least aportion of the elongate shaft is selectively movable in more than twodirections. An end effector may be coupled to the elongate shaft.

In accordance with other non-limiting embodiments of the presentinvention, there is provided an electrosurgical instrument that maycomprise an elongate shaft and a flexible electrode assembly that ismovably coupled to a distal end of the elongate shaft.

BRIEF DESCRIPTION OF THE DRAWINGS

Various features of the embodiments described herein are set forth withparticularity in the appended claims. The various embodiments, however,both as to organization and methods of operation, together withadvantages thereof, may be understood in accordance with the followingdescription taken in conjunction with the accompanying drawings asfollows.

FIG. 1 is a perspective view of an electrosurgical instrument accordingto one non-limiting embodiment of the present invention;

FIG. 2 is a side view of the handle depicted in FIG. 1 with a portion ofthe housing thereof omitted to illustrate various handle components;

FIG. 3 is a top view of an end effector according to one non-limitingembodiment of the present invention;

FIG. 4 is a partial perspective view of the end effector embodimentdepicted in FIG. 3 in an open position;

FIG. 5 is a partial perspective view of a portion of a translatablemember according to one non-limiting embodiment of the present inventionwith an alternative flexed position shown in phantom;

FIG. 6 is a perspective view of a portion of a translatable memberaccording to another non-limiting embodiment of the present invention;

FIG. 7 is a partial cross-sectional perspective view of a translatablemember according to another non-limiting embodiment of the presentinvention;

FIG. 8 is a perspective view of an electrosurgical instrument accordingto another non-limiting embodiment of the present invention;

FIG. 9 is a partial perspective view of an end effector of anothernon-limiting embodiment of the present invention in an open position;

FIG. 10 is another partial perspective view of the end effector of FIG.9 in a closed position;

FIG. 11 is a cross-sectional view of the end effector of FIG. 10 takenalong line 11-11 in FIG. 10;

FIG. 12 is a top diagrammatical view of the end effector of FIGS. 9 and10 with alternative flexed positions being shown in phantom;

FIG. 13 is a perspective view of an electrosurgical instrument accordingto another non-limiting embodiment of the present invention;

FIG. 14 is a side view of the handle depicted in FIG. 13 with a portionof the housing thereof omitted to illustrate various handle components;

FIG. 15 is a side elevational view of an end effector according toanother non-limiting embodiment of the present invention with the jawmembers thereof in a closed position;

FIG. 16 is a partial perspective view of the end effector of FIG. 15 inan open position;

FIG. 17 is a top diagrammatical view of the end effector of FIGS. 15 and16 with alternative flexed positions being shown in phantom;

FIG. 18 is a perspective view of a portion of another end effectoraccording to another non-limiting embodiment of the present invention;

FIG. 19 is a perspective view of a portion of another end effectoraccording to another non-limiting embodiment of the present invention;

FIG. 20 is a perspective view of a portion of another end effectoraccording to another non-limiting embodiment of the present invention;

FIG. 21 is a side view of the end effector embodiment of FIG. 20 beingused to dissect tissue;

FIG. 22 is a perspective view of an electrosurgical instrument accordingto another non-limiting embodiment of the present invention;

FIG. 23 is a cross-sectional view of the end effector depicted in FIG.22 in a closed position;

FIG. 24 is a top cross-sectional view of the lower jaw of the endeffector of FIG. 23 in a partially articulated position;

FIG. 25 is another top cross-sectional view of the lower jaw of FIG. 24in a straight position;

FIG. 26 is a partial perspective view of an end effector according toanother non-limiting embodiment of the present invention with a portionof a translatable member thereof shown in phantom;

FIG. 27 is a side elevational view of a portion of the translatablemember depicted in FIG. 26 with the end effector jaw portions shown inphantom;

FIG. 28 is a perspective view of an electrosurgical instrument accordingto another non-limiting embodiment of the present invention;

FIG. 29 is a partial perspective view of a portion of an articulatableelongate shaft according to a non-limiting embodiment of the presentinvention;

FIG. 30 is a perspective view of a spine segment according to anembodiment of the present invention;

FIG. 31 is a cross-sectional view of the spine segment of FIG. 30;

FIG. 32 is a partial side elevational view of the articulatable elongateshaft depicted in FIGS. 29-31 attached to an end effector;

FIG. 33 is a side elevational view of an electrosurgical instrumentaccording to another non-limiting embodiment of the present invention;

FIG. 34 is a side elevational view of the end effector depicted in FIG.33, with alternative positions illustrated in phantom;

FIG. 35 is another side elevational view of the end effector of FIG. 34engaging tissue;

FIG. 36 is a perspective view of an end effector according to anotherembodiment of the present invention; and

FIG. 37 is a cross-sectional view of a portion of the end effector ofFIG. 36 taken along line 37-37 in FIG. 36.

Corresponding reference characters indicate corresponding partsthroughout the several views. The exemplifications set out hereinillustrate various embodiments of the invention, in one form, and suchexemplifications are not to be construed as limiting the scope of theinvention in any manner.

DETAILED DESCRIPTION

Various embodiments are directed to apparatuses, systems, and methodsfor the treatment of tissue. Numerous specific details are set forth toprovide a thorough understanding of the overall structure, function,manufacture, and use of the embodiments as described in thespecification and illustrated in the accompanying drawings. It will beunderstood by those skilled in the art, however, that the embodimentsmay be practiced without such specific details. In other instances,well-known operations, components, and elements have not been describedin detail so as not to obscure the embodiments described in thespecification. Those of ordinary skill in the art will understand thatthe embodiments described and illustrated herein are non-limitingexamples, and thus it can be appreciated that the specific structuraland functional details disclosed herein may be representative andillustrative. Variations and changes thereto may be made withoutdeparting from the scope of the claims.

Reference throughout the specification to “various embodiments,” “someembodiments,” “one embodiment,” or “an embodiment”, or the like, meansthat a particular feature, structure, or characteristic described inconnection with the embodiment is included in at least one embodiment.Thus, appearances of the phrases “in various embodiments,” “in someembodiments,” “in one embodiment,” or “in an embodiment”, or the like,in places throughout the specification are not necessarily all referringto the same embodiment. Furthermore, the particular features,structures, or characteristics may be combined in any suitable manner inone or more embodiments. Thus, the particular features, structures, orcharacteristics illustrated or described in connection with oneembodiment may be combined, in whole or in part, with the featuresstructures, or characteristics of one or more other embodiments withoutlimitation.

It will be appreciated that the terms “proximal” and “distal” may beused throughout the specification with reference to a clinicianmanipulating one end of an instrument used to treat a patient. The term“proximal” refers to the portion of the instrument closest to theclinician and the term “distal” refers to the portion located furthestfrom the clinician. It will be further appreciated that for concisenessand clarity, spatial terms such as “vertical,” “horizontal,” “up,” and“down” may be used herein with respect to the illustrated embodiments.However, surgical instruments may be used in many orientations andpositions, and these terms are not intended to be limiting and absolute.

Various embodiments of systems and methods of the invention relate tocreating thermal “welds” or “fusion” within native tissue volumes. Thealternative terms of tissue “welding” and tissue “fusion” may be usedinterchangeably herein to describe thermal treatments of a targetedtissue volume that result in a substantially uniform fused-togethertissue mass, for example, in welding blood vessels that exhibitsubstantial burst strength immediately post-treatment. The strength ofsuch welds is particularly useful for (I) permanently sealing bloodvessels in vessel transaction procedures; (ii) welding organ margins inresection procedures; (iii) welding other anatomic ducts whereinpermanent closure is required; and also (iv) for performing vesselanastomosis, vessel closure or other procedures that join togetheranatomic structures or portions thereof. The welding or fusion of tissueas disclosed herein is to be distinguished from “coagulation”,“hemostasis” and other similar descriptive terms that generally relateto the occlusion of blood flow within small blood vessels or vascularzed tissue. For example, any surface application of thermal energy cancause coagulation or hemostasis—but does not fall into the category of“welding” as the term is used herein. Such surface coagulation does notcreate a weld that provides any substantial strength in the treatedtissue.

At the molecular level, the phenomena of truly “welding” tissue asdisclosed herein may result from the thermally-induced penetration ofcollagen and other protein molecules in a targeted tissue volume tocreate a transient liquid or gel-like pertinacious amalgam. A selectedenergy density is provided in the targeted tissue to cause hydrothermalbreakdown of intra- and intermolecular hydrogen crosslink's in collagenand other proteins. The denatured amalgam is maintained at a selectedlevel of hydration—without desiccation—for a selected time intervalwhich can be very brief. The targeted tissue volume is maintained undera selected very high level of mechanical compression to ensure that theunwound strands of the denatured proteins are in close proximity toallow their intertwining and entanglement. Upon thermal relaxation, theintermixed amalgam results in protein entanglement as re-cross linkingor repatriation occurs to thereby cause a uniform fused-together mass.

Various embodiments disclosed herein provide electrosurgical jawstructures adapted for transecting captured tissue between the jaws andfor contemporaneously welding the captured tissue margins withcontrolled application of RF energy. The jaw structures of certainembodiments can comprise first and second opposing jaws that carrypositive temperature coefficient (PTC) or resistance bodies formodulating RF energy delivery to the engaged tissue.

FIG. 1 shows an electrosurgical instrument 100 according to anon-limiting embodiment of the invention. Electrosurgical instrument 100comprises a proximal handle 105, a distal end effector 200, and anintroducer or elongate shaft member 106 disposed in-between. In variousembodiments, end effector 200 comprises a set of operable-closeable jaws220A and 220B. The end effector 200 may be adapted for capturing,welding, and transecting tissue, for example. First jaw 220A and secondjaw 220B may close to thereby capture or engage tissue therebetween.First jaw 220A and second jaw 220B may also apply compression to thetissue. In alternative embodiments, the end effector may be comprised ofone or two movable jaws.

Moving now to FIG. 2, a side view of the handle 105 is shown with halfof a first handle body 106A (see FIG. 1) being removed to illustratesome of the components within second handle body 106B. Handle 105 maycomprise a lever arm 128 which may be pulled along a path 129. Lever arm128 may be coupled to a translatable member 140 that is disposed withinthe elongate shaft 106 by a shuttle 146 that is operably engaged to anextension 127 of lever arm 128. The shuttle 146 may further be connectedto a biasing device, such as spring 141. The spring 141 may also beconnected to the second handle body 106B, to bias the shuttle 146 andthus the translatable member 140 in a proximal direction, thereby urgingthe jaws 220A and 220B to an open position as seen in FIG. 1. Also,referring to FIGS. 1 and 2, a locking member 131 (see FIG. 2) may bemoved by a locking switch 130 (see FIG. 1) between a locked position,where the shuttle 146 is substantially prevented from moving distally asillustrated, and an unlocked position, where the shuttle 146 may beallowed to freely move in the distal direction, toward the elongateshaft 106. The handle 105 can be any type of pistol-grip or other typeof handle known in the art that is configured to carry actuator levers,triggers or sliders for actuating the first jaw 220A and second jaw220B. Elongate shaft 106 may have a cylindrical or rectangularcross-section and can comprise a thin-wall tubular sleeve that extendsfrom handle 105. Elongate shaft 106 may have a bore extendingtherethrough for carrying actuator mechanisms such as, for example,translatable member 140, for actuating the jaws 220A, 220B and forcarrying electrical leads for delivery of electrical energy toelectrosurgical components of end effector 200.

The elongate shaft member 106 along with first jaw 220A and second jaw220B may, in some embodiments, be continuously rotatable in either aclockwise or counterclockwise direction, as shown by arrow 117 (FIG. 1),relative to handle 105 through, for example, a rotary triple contact.First jaw 220A and second jaw 220B can remain operable-closeable andopenable while being rotated. First jaw 220A and second jaw 220B may becoupled to the electrical source 145 and controller 150 throughelectrical leads in cable 152 to function as paired bi-polar electrodeswith a positive polarity (+) and a negative polarity (−) oralternatively monopolar electrodes with positive (+) polarity and aremote grounding pad with a negative (−) polarity.

The first jaw 220A may have a first elongate portion 221A that ispivotally coupled to a second elongate portion 221B of the second jaw220B by, for example, pins, grunions, or other known attachmentarrangement such that the first jaw 220A may be pivoted toward and awayfrom the second jaw 220B as represented by arrow 251 in FIG. 4. Further,the first jaw 220A and second jaw 220B may each have tissue-grippingelements, such as teeth 243, disposed on the inner portions of first jaw220A and second jaw 220B. First jaw 220A may comprise a first jaw body231A with a first outward-facing surface 232A and a first energydelivery surface 235A. Second jaw 220B may comprise a second jaw body231B with a second outward-facing surface 232B and a second energydelivery surface 235B. First energy delivery surface 235A and secondenergy delivery surface 235B may, for example, both extend in a “U”shape about the distal end of working end 200.

As can be seen in FIGS. 1 and 3, the elongate shaft 106 defines a firstlongitudinal axis A-A. In various non-limiting embodiments, the firstand second elongate portions 221A, 221B of the first and second jaws220A, 220B, respectively are aligned along a second axis B-B that isoffset from the first axis A-A. As can be further seen in FIG. 4, thefirst jaw body 231A may have a curved distal portion 222A and the secondjaw body 231B may have a curved distal portion 222B. FIG. 3 is a topview of the end effector 200 and illustrates an embodiment wherein thefirst jaw 220A and the second jaw 220B have substantially matchingshapes. As used herein, the terms “substantially” and “substantially thesame” refer to characteristics or components that are otherwiseidentical, but for the normal manufacturing tolerances commonlyexperienced when manufacturing such components. As can be further seenin FIG. 3, the distal tip portion 224A of the jaw body 231A as well asthe distal tip portion 224B of the second jaw body 231B are preferablylocated within the diameter “D” or “footprint FP” (for elongate shafts106 that do not have a circular cross-sectional shape) of the elongateshaft 106 such that the end effector 200 may be inserted through anopening that can accommodate the elongate shaft 106. The offset natureof the end effector 200 enables the jaws 220A, 220B to be provided witha curved or irregular portion that is curved relatively sharper thanother jaw embodiments wherein the jaws are axially aligned with theelongate shaft 106. It will be understood that the jaws 220A, 220B mayhave various curved portions, provided that no portion of the jaws 220A,220B protrude laterally outward beyond the diameter “D” or footprint FPof the elongate shaft 106 for a distance that might otherwise preventthe insertion through a lumen such as, for example, a trocar or the likeunless it is deflectable thereby allowing insertion through such alumen.

FIGS. 3-5 show a portion of translatable, reciprocating member orreciprocating “I-beam” member 240. The lever arm 128 of handle 105 maybe adapted to actuate translatable member 240 which also functions as ajaw-closing mechanism. For example, translatable member 240 may be urgeddistally as lever arm 128 is pulled proximally along path 129. Thedistal end of translatable member 240 comprises a flanged “I”-beam thatis configured to slide within slots 242 in jaws 220A and 220B. See FIG.4. Translatable member 240 slides within slots 242 to open and closefirst jaw 220A and second jaw 220B. As can be most particularly seen inFIG. 5, the distal end of translatable member 240 comprises an upperflange 244 and a lower flange 246 that are separated by a web portion248 that has a sharpened distal end 250 for cutting tissue. In variousembodiments, the translatable member 240 may be fabricated from, forexample, stainless steel or similar elastic materials or alternativelyfrom the class of superelastic materials such as Nitinol or the like. Invarious embodiments, the upper flange 244 and the lower flange 246 oftranslatable member 240 may each be optionally provided with cutoutportions 252. The cutouts 252 may be substantially V-shaped with theirnarrowest portion adjacent the web 248 and their widest portion openingat the lateral edge of the flange as shown in FIG. 5. The cutouts 252 inthe upper flange 244 may be substantially aligned with like cutouts 252in the lower flange 246. To facilitate relatively tight bending of thetranslatable member 240 (as illustrated in phantom lines in FIG. 5), thecutouts 252 may be oriented relatively close together. Such translatablemember arrangements enable the translatable member to flex around thecurved slots 242 in the first and second jaws 220A, 220B. Thus, as thetranslatable member 240 is advanced distally by actuating the lever 128,the upper and lower flanged portions 244, 246 engage the first jaw 220Aand the second jaw 220B to cam the jaws 220A, 220B together to clamp andcut tissue therebetween.

FIG. 6 illustrates another translatable member 240′ that is similar totranslatable member 240 described above, except that a tissue-cuttingwire 260 is provided between the upper and lower flanges for tissuecutting purposes. The wire 260 may be fabricated from, for example,stainless steel or the like and be mounted in tension between the upperflange 244 and the lower flange 246. The wire 260 may also be used inconnection with a translatable member 240 that does not have the cutouts252 in its flanges 244, 246. In an alternative embodiment, the wire 260may be connected to the RF power source either directly or indirectly tocut electrically.

In various embodiments, the translatable member 240 may be provided withthe cut outs 252 as described above and be fabricated from, for example,a relatively flexible or super elastic material or alloy such asNitinol, NiTi or other alloys with similar properties. In otherembodiments, the translatable member may be fabricated out of Nitinol,NiTi or similar material and have the shape of an I-beam without the cutouts 252 in the flanges. See FIG. 7.

FIGS. 8-11 illustrate another electrosurgical instrument 300 thatemploys another non-limiting end effector embodiment 400 of the presentinvention. The electrosurgical instrument 300 may be identical inconstruction and operation as electrical surgical instrument 100 exceptfor the differences noted below. Turning to FIGS. 9 and 10, it can beseen that the end effector 400 includes a first jaw 420A and a secondjaw 420B. The first jaw 420A may be pivotally coupled to the second jaw420B to enable the first jaw 420A to pivot between an open position(FIG. 9) and a closed position (FIG. 10). First jaw 420A may comprise anupper first jaw body 431A that is formed from a series of verticallylaminated layers 432A of material. In various embodiments, the laminatedlayers 432A may be fabricated from materials that comprise a thermaland/or electrical insulator, for example, zirconium, partiallystabilized zirconium, aluminum oxide, silicon nitride, alumina-chromic,hydroxyapatite, other non-conductive glass materials, or othernon-conductive ceramic materials. Other non-conductive glass-ceramicmaterials may also be employed. The layers 432A may be verticallylaminated together by an electrometric material 434A such as, forexample, polyisoprene, silicone, etc. See FIG. 11. The laminated layers432A may serve to define a slot 442A for accommodating a translatablemember 240 or 240′ in the manner described above. The first jaw body431A has an upper first outward-facing surface 433A and an upper firstenergy delivery surface 435A. As used herein, the term “verticallylaminated” means that the layers of material extend perpendicular to aplane along with the energy delivery surface lies. Second jaw 420B maycomprise a lower second jaw body 431B that is formed from another seriesof vertically laminated layers 432B that may be fabricated and laminatedfrom the various materials described above. The second jaw body 431B mayhave a lower second outward-facing surface 433B and a lower secondenergy delivery surface 435B. First energy delivery surface 435A andsecond energy delivery surface 435B may both extend in a “U” shape aboutthe distal end of the end effector 200.

As seen in FIG. 11, electrosurgical energy may be delivered throughcurrent paths 477 between first energy delivery surface 435A and secondenergy delivery surface 435B. Translatable member 240 may comprise aninsulating layer to prevent member 240 from functioning as a conductivepath for current delivery. Opposing first and second energy deliverysurfaces 435A and 435B may carry variable resistive positive temperaturecoefficient (PTC) bodies or matrices that are coupled to electricalsource 145 and controller 150 in series and parallel circuit components.First energy delivery surface 435A and the corresponding PTC body canhave a negative polarity (−) while second energy delivery surface 435Band the corresponding PTC body can have a positive polarity (+). PTCmaterials will “trip” and become highly resistive or non-conductive oncea selected trip temperature is exceeded. First energy delivery surface435A and second energy delivery surface 435B can carry any of the PTCmatrix and electrode components disclosed in U.S. Pat. No. 6,929,644entitled ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLED ENERGY DELIVERYand U.S. Pat. No. 6,770,072 entitled ELECTROSURGICAL JAW STRUCTURE FORCONTROLLED ENERGY DELIVERY, the respective disclosures of which are eachfully incorporated herein by reference. The use of PTC materials inelectrosurgical instruments is also described in U.S. Pat. No. 7,112,201entitled ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLED ENERGY DELIVERY,U.S. Pat. No. 6,929,622 entitled ELECTROSURGICAL JAW STRUCTURE FORCONTROLLED ENERGY DELIVERY, and U.S. Patent Application Publication No.2010/0036370 entitled ELECTROSURGICAL INSTRUMENT JAW STRUCTURE WITHCUTTING TIP, the respective disclosures of which are each fullyincorporated herein by reference. In various embodiments, however, thefirst energy delivery surface 435A and the second energy deliverysurface 435B are each fabricated from layers that are laminated togetherby, for example, adhesive or mechanical means.

FIG. 12 is a top diagrammatical view of the end effector 400 and anactuating system 491 that may be employed to flex the end effector 400between the three positions illustrated therein. As can be seen in thatFigure, the actuating system 491 may comprise at least one “first” cable492 attached to each of said first and second jaws 420A, 420B. That isat least one first cable 492 is attached to the first jaw 420A and atleast one other first cable 492 is attached to the second jaw 420B.Likewise, at least one “second” cable 496 is attached to each of thefirst jaw 420A and the second jaw 420B. That is, at least one secondcable 496 is attached to the first jaw 420A and at least one othersecond cable 496 is attached to the second jaw 420B. Such actuationsystem 491 enables the clinician to “pull” portions of the first jaw420A and portions of the second jaw 420B out of axial alignment with theelongate shaft 106. That is, for example, the first cables 492 may beused to pull portions of the first and second jaws 420A, 420B to theleft of axis 125 and the second cables 496 may be used to pull portionsof the first and second jaws 420A, 420B to the right of the axis 125.The first cables 492 may extend through the hollow elongated shaft 106to be coupled to a first actuation member 494 that is operably supportedby the handle 105. See FIG. 12. Similarly, the second cables 496 mayextend through the hollow elongated shaft 106 to be coupled to a leftactuation member 498 that is operably supported by the handle 105. Forexample, each actuation member 494, 498 may comprise a lever arm,button, etc. that is movably supported on the handle 105 and coupled tothe corresponding cables 492, 496 such that movement of the actuationmember 494 in one direction applies tension to the cables 492 to causethe end effector to flex to one side of axis 125. Movement of theactuation members 494, 498 in other directions permits the cables 492,496 to assume positions wherein the end effector 400 can assume arelatively coaxial orientation with the elongated shaft member 106 topermit insertion of the end effector 400 through a lumen that willaccept the hollow elongated shaft member 106. Similarly, movement of theactuation member 498 in one direction applies tension to the cables 496to flex the end effector 400 to another side of axis 125. The actuationmembers 494, 498 may be selectively lockable in the various positionsusing known locking arrangements. In still other embodiments, one ormore motors may be employed to apply tension to and relieve tension fromthe cables to effectuate a desired flexing or bending of the endeffector 400. It will be understood that the end effector 400 mayotherwise operate in the various manners disclosed herein and that theunique and novel design of the translatable member 240 or 240′ may flexor bend to travel through the respective slots 442A, 442B.

FIGS. 13-17 illustrate an electrosurgical instrument 500 according toanother non-limiting embodiment of the present invention. Thisembodiment may employ a handle 105′ that is somewhat similar to handle105 described above. However, the electrosurgical instrument 500 doesnot employ a translatable member that is designed to cut tissue andclose the jaws 520A and 520B of the end effector 510. In thisembodiment, the second jaw 520B is coupled to a spine member 530 thatextends through the hollow elongate tube 106 and is attached to thehandle 105′. The proximal end of the hollow elongate tube 106 interfaceswith a shuttle member 146 that is movably supported in handle 105′ andinterfaces with the lever 128 such that pivotal movement of the leverarm 128 along path 129 will cause the shuttle 146 and elongate tube 106to move axially relative to the handle 105′ and the spine member 530 asrepresented by arrow 523. See FIGS. 14 and 15. Such closure arrangementsare generally known in the art relating to other forms of surgicalinstruments, such as, for example, endocutters and the like. See, forexample, U.S. Pat. No. 7,588,176 entitled SURGICAL CUTTING INSTRUMENTWITH IMPROVED CLOSURE SYSTEM and U.S. Pat. No. 7,665,647 entitledSURGICAL CUTTING AND STAPLING DEVICE WITH CLOSURE APPARATUS FOR LIMITINGMAXIMUM TISSUE COMPRESSION FORCE, the disclosures of which are hereinincorporated by reference in their respective entireties.

Referring now to FIG. 15, the first jaw 520A is pivotally coupled to thesecond jaw 520B for selective pivotal travel relative to the second jaw520B (represented by arrow 521) upon the axial movement of the elongatetube 106 represented by arrow 523. First jaw 520A may comprise an upperfirst jaw body 531A that is formed from a series of vertically laminatedlayers 532A. See FIG. 16. In various embodiments, the laminated layers532A may be fabricated from materials that comprise a thermal and/orelectrical insulator, for example, zirconium, partially stabilizedzirconium, aluminum oxide, silicon nitride, alumina-chromic,hydroxyapatite, other non-conductive glass materials, or othernon-conductive ceramic materials. Other non-conductive glass-ceramicmaterials may be employed. The layers 532A may be laminated together byan elastomeric material such as, for example, polyisoprene, silicone,etc. The first jaw body 531A has an upper first outward-facing surface533A and an upper first energy delivery surface 535A. Second jaw 520Bmay comprise a lower second jaw body 531B that is formed from anotherseries of laminated layers 532B that may be fabricated and laminatedfrom the various materials described above. The second jaw body 531B mayhave a lower second outward-facing surface 533B and a lower secondenergy delivery surface 535B. First energy delivery surface 535A andsecond energy delivery surface 535B may both extend in a “U” shape aboutthe distal end of the end effector 510 and comprise vertical laminatedlayers of material. As discussed above, electrosurgical energy may bedelivered through current paths between first energy delivery surface535A and second energy delivery surface 535B. The first energy deliverysurface 535A and the second energy delivery surface 535B may beconfigured to contact tissue and deliver electrosurgical energy toengaged tissue which is adapted to seal or weld the tissue. Opposingfirst and second energy delivery surfaces 535A and 535B may carry avariable resistive positive temperature coefficient (PTC) layer 540 thatis coupled to electrical source 145 and controller 150 in series andparallel circuit components. First energy delivery surface 535A and thecorresponding PTC layer 540 can have a negative polarity (−) whilesecond energy delivery surface 535B and the corresponding PTC body 540can have a positive polarity (+). PTC materials will “trip” and becomesubstantially more resistive or non-conductive once a selected triptemperature is exceeded. First energy delivery surface 535A and secondenergy delivery surface 435B can carry any of the PTC matrix andelectrode components in a laminated arrangement. Controller 150 canregulate the electrical energy delivered by electrical source 145 whichin turn delivers electrosurgical energy to first energy delivery surface535A and second energy delivery surface 535B. The energy delivery may beinitiated by activation button 124 operably engaged with lever arm 128and in electrical communication with controller 150 via cable 152. Asmentioned above, the electrosurgical energy delivered by electricalsource 145 may comprise radio frequency “RF” energy.

To facilitate flexible travel of the end effector 510 in the manners,for example, depicted in FIG. 17, an actuating arrangement 600 of thetype described above may be employed. In particular, the actuatingarrangement may comprise left cables 602 and right cables 606 that areattached to the first jaw 520A and the second jaw 520B to essentiallyenable the clinician to “pull” the first jaw 520A and second jaw 520B tothe left and right of the axis 125. The right cables 606 may extendthrough the hollow spine member 530 to be coupled to a right actuationmember 608 that is operably supported by the handle 105′. See FIGS. 13and 17. Similarly, the left cables 602 may extend through the hollowspine member 530 to be coupled to a left actuation member 604 that isoperably supported by the handle 105′. For example, each actuationmember 604, 608 may comprise a lever arm, button, etc. that is movablysupported on the handle 105′ and coupled to the corresponding cables602, 606 such that movement of the actuation member 604, 608 in onedirection applies tension to the cables 602, 606 and movement of theactuation member 604, 608 in another direction permits the cables 602,606 to assume positions wherein the end effector 510 can assume arelatively coaxial orientation with the elongated member 106 to permitinsertion of the end effector 510 through a lumen that will accept thehollow elongated member 106. The actuation members 604, 608 may beselectively lockable in the various positions using known lockingarrangements. In still other embodiments, one or more motors may beemployed to apply tension to and relieve tension from the cables toeffectuate a desired flexing of the end effector 510.

FIG. 18 illustrates an end effector 700 according to anothernon-limiting embodiment of the present invention. End effector 700 maycomprise a flexible end effector of the type described above or it couldbe essentially rigid. The end effector 700 has a first jaw 720A that ismovably supported relative to a second jaw 720B. In various non-limitingembodiments, for example, the first jaw 720A may be pivotally coupled toor is otherwise pivotable relative to a second jaw 720B by means of theaxial displacement of the elongate tube 106 in the various mannersdescribed above. As with various other embodiments described above, thefirst jaw 720A has a first jaw body 731A that has a width “W”, an upperfirst outward-facing surface 733A, an upper first energy deliverysurface 735A and a distal end 737A. Second jaw 720B may comprise a lowersecond jaw body 731B that also has a width “W” which may or may not beidentical to width “W” of the first jaw body 731 A and thus enable theend effector 700 to be conveniently inserted through a trocar or otherlumen. The second jaw body 731B may have a second outward-facing surface733B, a second energy delivery surface 735B and a second distal end737B. First energy delivery surface 735A and second energy deliverysurface 735B may both extend in a “U” shape about the distal end of theend effector 700. The energy delivery surfaces 735A, 735B may otherwiseoperate in the various manners described above. In this embodiment, toassist the surgeon with dissecting the target tissue to be cauterized, adistally extending blunt tip 760 may be provided on one or both of thefirst and second jaws 735A, 735B. The blunt tip 760 may be relativelysmooth or in other embodiments, the blunt tip 760 may be coated with orotherwise provided with fibrous structures 761 to allow betternon-powered dissection. As can be seen in FIG. 18, the blunt tip 760 mayhave a diameter or width “D” that is less than the widths “W”, “W” toenable the tip 760 to be more easily inserted into areas in which thejaws 720A, 720B could not otherwise enter. In still other embodiments,an electrode (not shown) may be provided in the tip 760 such that it isconfigured to work as a monopolar dissector or alternatively a bipolardissector.

In other non-limiting embodiments, the end effector 700′ may have ablunt tip portion 760′ that is pivotally coupled to an extension 764that protrudes from one or both of the first and second jaws 720A, 720B.See FIG. 19. The blunt tip portion 760′ may be pivotally coupled to theextension 764 by a hinge 766 that will frictionally retain the blunt tipportion 760′ in a desired articulated position. For example, the surgeonmay bring the blunt tip portion 760′ into contact with tissue or otherstructure to pivot the blunt tip portion 760′ to a desired positionabout a vertical axis VA-VA that is substantially transverse to alongitudinal axis LA-LA. The blunt tip portion 760′ may be retained inthat position by friction between the components of the hinge 766. WhileFIG. 19 illustrates that the blunt tip portion is attached to theextension 764 for pivotal travel about a vertical axis, the blunt tipportion 760′ may be attached to the extension 764 for selective pivotaltravel about a horizontal axis (not shown). In still other non-limitingembodiments, the blunt tip portion 760′ may be movably coupled to theextension by a “universal” hinge arrangement that facilitates pivotalpositioning of the blunt tip portion 760′ about a horizontal axis and avertical axis and thereafter retained in such desired position byfriction. In still other non-limiting embodiments, the blunt tip portion760 may be attached to extension 764 by a plurality of hinges andintermediate tip portions to further enable the blunt tip portion to bepositioned in a desired orientation for dissection purposes.Alternatively, the blunt tip portion may be formed on the jaw members(s)and be constructed of a malleable material that allows the user topre-sect the shape prior to insertion into the patient or afterinsertion with the use of another instrument.

FIGS. 20 and 21 illustrate an end effector 800 of another non-limitingembodiment of the present invention that may be identical to the endeffector 700 except for the differences noted below. End effector 800may comprise a flexible end effector of the type described above or itcould be essentially rigid (not capable of flexing out of axialalignment with the elongate tube 106). The end effector 800 has a firstjaw 820A that is pivotally coupled to or is otherwise pivotable relativeto a second jaw 820B by means of the axial displacement of the elongatetube 106 in the various manners described above. As with various othernon-limiting embodiments described above, the first jaw 820A has a firstjaw body 831A that has a first outward-facing surface 833A and a firstenergy delivery surface 835A. Second jaw 820B may comprise a lowersecond jaw body 831B that has a second outward-facing surface 833B and asecond energy delivery surface 835B. First energy delivery surface 835Aand second energy delivery surface 835B may both extend in a “U” shapeabout the distal end of the end effector 800. The energy deliverysurfaces 835A, 835B may otherwise operate in the various mannersdescribed above. In this embodiment, to assist the surgeon withdissecting or otherwise separating the target tissue to be cauterized, adistally extending first tip 860A may be provided on the first jaw 820Aand a distally extending second tip 860B may be provided on the secondjaw 820B. The first tip 860A may have a tapered outwardly facing surface861A and a relatively planar inwardly facing surface 862A. Tissuegripping grooves 865A or bumps or other structures may be provided onthe outer facing surface 861A and or inwardly facing surface 862A.Similarly, the second tip 860B may have a tapered outwardly facingsurface 861B and a relatively planar inwardly facing surface 862B.Tissue gripping grooves 865B or bumps or other structures may beprovided on the outer facing surface 861B and/or the inwardly facingsurface 862B.

In various non-limiting embodiments, the first and second tips 860A,860B are not powered. In other non-limiting embodiments, however, thetip 860A comprises a portion of the first energy delivery surface 835Aor otherwise has an electrode portion therein. Likewise, the second tip860B comprises a portion of the second energy delivery surface 835B orotherwise has an electrode portion therein. When powered, the energy mayarc from tip to tip in a bipolar configuration or tip to tissue in amonopolar configuration. FIG. 21 illustrates one potential use of theend effector 800 to separate or dissect tissue “T”.

FIGS. 22-25 illustrate an electrosurgical instrument 900 according toanother non-limiting embodiment of the present invention. Thisnon-limiting embodiment may employ a handle 105′ that is somewhatsimilar to handle 105 described above. However, the electrosurgicalinstrument 900 does not employ a translatable member that is designed tocut tissue and close the jaws 920A and 920B of an end effector 910. Inthis embodiment, the second jaw 920B is coupled to a spine member 930(FIG. 23) that extends through the hollow elongate tube 106 and isattached to the handle 105′ in the manner described above. Axial travelof the elongate tube 106 causes the first jaw 920A to pivot relative tothe second jaw 920B. Other jaw closing mechanisms may also be employed.

First jaw 920A may comprise a series of pivotally interconnected firstbody segments 922A as shown in FIGS. 23-25. The first body segments 922Aare coupled together by a ball and socket-type joint arrangement 923Asuch that they may pivot relative to each other about a vertical axisVA-VA as shown in FIG. 23. Each first body segment 922A may befabricated from, for example, a thermal and/or electrical insulator. Forexample, zirconium, partially stabilized zirconium, aluminum oxide,silicon nitride, alumina-chromic, hydroxyapatite, other non-conductiveglass materials, other non-conductive ceramic materials, and othernon-conductive glass-ceramic materials may be employed. Each first bodysegment 922B further has a first energy delivery electrode 935A mountedtherein.

Similarly, the second jaw 920B may comprise a series of pivotallyinterconnected second body segments 922B that are pivotallyinterconnected by a ball and socket-type joint arrangement 923B as shownin FIGS. 24 and 25. The second body segments 922B are coupled togethersuch that they may pivot relative to each other about the vertical axesVA-VA as shown in FIG. 23. Each second body segment 922B corresponds toa first body segment 922A and may be fabricated from, for example, thesame or different material comprising the corresponding first bodysegment 922A. Each second body segment 922B further has a second energydelivery electrode 935B mounted therein that corresponds to, and issubstantially vertically aligned with, the first energy deliveryelectrode 935A in the corresponding first body segment 922A. The firstenergy delivery electrodes 935A and the second energy deliveryelectrodes 935B may be configured to contact tissue and deliverelectrosurgical energy to engaged tissue which is adapted to seal orweld the tissue. Opposing first and second energy delivery electrodes935A and 935B may be coupled to electrical source 145 and controller 150in series and parallel circuit components. First energy deliveryelectrode 935A and the first body segment 922A can have a negativepolarity (−) while second energy delivery surface 935B and thecorresponding second body segment 922B can have a positive polarity (+)or vice versa. The first and second body segments 922A, 922B materialsmay “trip” and become resistive or non-conductive once a selected triptemperature is exceeded. Controller 150 can regulate the electricalenergy delivered by electrical source 145 which in turn deliverselectrosurgical energy to the first energy delivery electrodes 935A andthe second energy delivery electrodes 9353B. The energy delivery may beinitiated by activation button 124 operably engaged with lever arm 128and in electrical communication with controller 150 via cable 152. Asmentioned above, the electrosurgical energy delivered by electricalsource 145 may comprise radio frequency “RF” energy and may be eithermonopolar or bipolar in nature.

In various non-limiting embodiments, once the first body segments 922Aare oriented in a desired orientation relative to each other, frictionbetween the ball and socket components 923A serve to retain the firstbody segments 922A in that position. Similarly, once the second bodysegments 922B are oriented in a desired orientation relative to eachother, friction between the ball and socket components 923B retain thesecond body segments 922B in that position. Optionally, a first lockingcable 929A may extend from a locking mechanism on the handle 105′through each first body segment 922A to the distal-most body segment922A. Once the body segments 922A have been moved to a desiredorientation, the surgeon may apply tension to the first locking cable929A by means of the locking mechanism to pull the first body segments922A together to thereby lock them in place. Likewise, a second lockingcable 929B may extend from the locking mechanism 940 or another lockingmechanism on the handle 105′ through each body segment 922B to thedistal-most body segment 922B. Once the body segments 922B have beenmoved to the desired orientation, the surgeon may apply tension to thesecond locking cable 929B to pull the second body segments 922B togetherto thereby lock them in place.

FIGS. 26 and 27 illustrate a portion of an end effector 1000 of anothernon-limiting embodiment of the present invention that includes a firstjaw 1020A and a second jaw 1020B. The first jaw 1020A may have a firsttapered distal end portion 1021A and the second jaw 1020B may have asecond tapered distal end portion 1021B that converges with the firsttapered distal end portion 1021A to form a substantially conical endeffector tip 1022 that is particularly well-suited for dissectionpurposes. The embodiment may further include a reciprocating I-beammember 1040 that may be identical in construction and operation as theI-beam members described above, except for the following differences.More specifically, as can be seen in FIG. 27, the I-beam member 1040 hasan upper flange 1042 and a lower flange 1044 that are interconnected bya central web portion 1046. The central web portion 1046 extends throughaligned slots (not shown) in the first jaw member 1020A and the secondjaw member 1020B in the manner described above. The upper flange 1042may ride in a groove, slot or recessed area in the first jaw member1020A and the lower flange 1044 may ride in a groove, slot or recessedarea in the second jaw member 1020B such that, as the I beam member 1040is distally advanced through the first and second jaw members 1020A,1020B, the upper and lower flanges 1042, 1044 pivot the first and secondjaws 1020A, 1020B together in the manner described above. As can be mostparticularly seen in FIG. 27, the lower flange 1044 protrudes further inthe distal direction than does the upper flange 1042. The portion of thecentral web 1046 that extends from the distal-most edge of the lowerflange 1044 to the distal-most edge of the upper flange 1042 has acutting edge 1047 formed thereon. In various embodiments, the cuttingedge 1047 may have an arcuate profile when viewed from the side. See,for example, FIG. 27. Such “recessed” I-beam arrangement, with anarcuate cutting surface, in combination with the tapered distal tip ofthe end effector, allows some compression of the first and second jaws1020A, 1020B without transecting the tissue clamped between the firstand second jaws 1020A, 1020B. Stated another way, as the I-beam isadvanced distally within the end effector, the portion of the cuttingsurface that protrudes out of the slot in the second jaw 1020B isproximal to the distal most end of the portion of I-beam advancingthrough the second jaw 1020B. In various applications, the jaws can beactuated to add surface coagulation to cutting for tissue laying on theextended portion of the lower jaw, for example. In still othernon-limiting embodiments, the distal edge of the web (i.e., edge 1047)may have a “C” shape or “U” shape. Stated another way, when viewed fromthe side, the edge 1047 may form a substantially horizontal “U” shape.Such unique I-beam configurations facilitate the compression of tissuebetween the jaws which serves to drive out water from the tissue.Current is then applied to the compressed tissue before it is ultimatelycut with the advancing cutting edge. As a result, more robust seals aregenerally attained.

FIGS. 28-31 illustrate an electrosurgical instrument 1100 according toanother non-limiting embodiment of the invention. Electrosurgicalinstrument 1100 comprises a proximal handle end 105″, a distal endeffector 1200 and an introducer or elongate shaft member 1106 disposedin-between. In this non-limiting embodiment, however, the elongate shaftmember 1106 includes a flexible spine assembly 1110 that is enclosed ina flexible hollow sheath 1112.

FIGS. 29-31 illustrate various spine assembly components. In particular,in at least one non-limiting embodiment, the spine assembly 1110 may befabricated from a plurality of interconnected spine segments 1120. Ascan be seen in FIGS. 30 and 31, each spine segment 1120 has a hollowbody 1122 that is somewhat cylindrical in shape. One end of the hollowbody 1122 has an outwardly protruding ball member 1124 formed thereon.The other end of the body 1122 has a socket 1126 that is sized torotatably receive and retain the ball member 1124 of an adjacent segment1120 therein. In various embodiments, the proximal-most segment 1122 maybe non-movably attached to actuator wheel 107 rotatably supported on thehandle 105″. See FIG. 28. Thus, rotation of the actuator wheel 107 willcause the spine assembly 1110 to rotate about axis 125. The distal-mostspine segment 1120 is attached to the end effector 1200. In oneembodiment, the end effector 1200 may include a set ofoperable-closeable jaws 1220A and 1220B. The end effector 1200 may beadapted for capturing, welding and transecting tissue. First jaw 1220Aand second jaw 12206 may close to thereby capture or engage tissuetherebetween. First jaw 1220A and second jaw 1220B may also applycompression to the tissue. The second jaw 1220B may be attached to thedistal-most spine segment 1120 and the first jaw 1220A may be pivotallyor otherwise movably coupled to the second jaw 1220B. In one embodiment,for example, the end effector 1200 may be identical in construction andoperation to end effector 200 described in detail above.

The electrosurgical instrument 1110 may also employ a translatable,reciprocating member or reciprocating “I-beam” member 240. The lever arm128 of handle 105″ may be adapted to actuate a flexible translatablemember 240 which also functions as a jaw-closing mechanism. For example,translatable member 240 may be urged distally as lever arm 128 is pulledproximally along path 129. The distal end of translatable member 240comprises a flexible flanged “I”-beam that is configured to interfacewith the first and second jaw members 1220A, 1220B in the mannerdescribed above. The flexible translatable member 240 extends throughthe lumen 1130 provided through each spine segment 1120. See FIG. 31.The distal end of the flexible translatable member 240 interfaces withthe first and second jaws 1220A, 1220B in the manner described above.Wires for powering the end effector 1200 may also extend through thelumen 1130 or extend through other passages (not shown) in the spinesegments 1120. The unique and novel aspects of the spine assembly 1110may also be employed with a host of other end effector arrangements. Forexample, the lumens 1130 in the spine segments 1120 may accommodate avariety of different actuator arrangements, wires, cables etc. that maybe used to control and actuate the end effector.

The spine assembly 1110 may be effectively flexed in more than twodirections (some of which are represented by arrows 1111 in FIG. 29) bya control assembly generally designated as 1300. In various embodiments,for example, control assembly 1300 may comprise at least one actuationmember 1310 that extends through corresponding aligned hollow lugs 1130formed on the perimeter of the hollow body 1122 of each spine segment1120. In the depicted embodiment, the actuation members 1310 comprisefour control cables. In alternative embodiments, however, three controlcables could be employed to essentially achieve the same degrees ofmotion achieved with four cables. U.S. Pat. No. 8,262,563, entitledENDOSCOPIC TRANSLUMENAL ARTICULATABLE STEERABLE OVERTUBE, the disclosureof which is herein incorporated by reference, discloses other steerabletubular arrangements that may be employed. In alternative embodiments,the control members 1310 may also comprise electrical conductors thatcommunicate with the RF source to carry the RF energy to the endeffector.

In the illustrated non-limiting embodiment, each spine segment 1122 hasfour diametrically opposed lugs 1130 formed thereon. Each of the controlcables 1310 extend through the hollow sheath 1106 and into the handle105″ to interface with articulation control mechanism 1400. In thedepicted embodiment, the articulation control mechanism 1400 comprises ajoy stick arrangement 1402 that is operably supported by the handle105″. Thus, movement of the joy stick arrangement 1402 will applytension to one or more of the cables 1310 to thereby cause the spineassembly 1110 to articulate. Other cable control arrangements could alsobe employed.

FIGS. 33-35 illustrate a monopolar electrosurgical instrument 1500according to another non-limiting embodiment of the present invention.Electrosurgical instrument 1500 comprises a proximal handle 105, adistal end effector 1600, and an introducer or elongated shaft member106 disposed in-between. The end effector 1600 in conjunction with areturn pad (not shown) may be adapted for controlled surface ablation inBarrett's esophagus, liver or endometriosis procedures. As will bediscussed in further detail below, the end effector 1600 is movablerelative to the elongate shaft 106 which makes it particularlywell-suited for laparoscopic or open procedural use.

Handle 105 may comprise a lever arm 128 which may be pulled along a path129. The handle 105 can be any type of pistol-grip or other type ofhandle known in the art that is configured to carry actuator levers,triggers, etc. Elongate shaft 106 may have a cylindrical or rectangularcross-section and can comprise a thin-wall tubular sleeve that extendsfrom handle 105. Elongate shaft 106 may be fabricated from, for example,metal such as stainless steel or plastics such as Ultem®, or Vectra®,etc. In still other embodiments, the elongate shaft 106 may comprise apolyolefin heat shrunk tube and have a bore extending therethrough forcarrying actuator cables or members as well as for carrying electricalleads for delivery of electrical energy to electrosurgical components ofend effector 1600. The elongate shaft member 106 along with the endeffector 1600 may, in some embodiments, be rotatable a full 360° aboutan axis 125, relative to handle 105 through, for example, a rotarytriple contact.

The end effector 1600 may comprise a pad support 1602 that is pinned orotherwise movably coupled to a distal end 107 of the elongate shaft 106.In various embodiments, the pad support 1602 may be fabricated fromrelatively flexible material such as, for example, poly carbonate or arelatively high durometer silicone elastomer. However, other materialsmay be employed. Attached to the flexible pad support 1602 is aconductor or electrode element 1604 and a flexible pad member 1606 thatis fabricated from positive temperature coefficient (PTC) material. Forexample, the flexible pad member 1604 may be fabricated from that PTCmaterial disclosed in U.S. Pat. No. 6,770,072, entitled ELECTROSURGICALJAW STRUCTURE FOR CONTROLLED ENERGY DELIVERY, the disclosure of which isherein incorporated by reference in its entirety. The conductor orelectrode element 1604 may be fabricated from, for example, metals suchas stainless steel or copper and be coupled to an RF source 145 andcontroller 150 through electrical leads in cable 152. Such end effector1600 includes an activation control button 131 that facilitates theapplication of controlled energy to tissue. The energy delivery may beinitiated by activation button 131 in electrical communication withcontroller 150 via cable 152. As mentioned above, the electrosurgicalenergy delivered by electrical source 145 may comprise radio frequency“RF”. Lever 128 can provide control of the pad support 1602 relative tothe elongate shaft 106 for better alignment and approximation of the pad1602 to the tissue. The lever 128 may alternatively control articulationof the elongate shaft proximal the distal end of the elongate shaft 107.

This embodiment of the present invention provides the ability to supplycurrent/power to targeted tissue at a predetermined critical temperaturelevel. This is accomplished when the applied RF energy to the tissuereaches the point in time that the PTC pad 1606 is heated to itsselected switching range. Thereafter, current flow from the conductiveelectrode 1604 through the flexible pad 1606 will be terminated due tothe exponential increase in the resistance of the PTC to provide instantand automatic reduction of RF energy. Thus, the end effector 1600 canautomatically modulate the application of energy to tissue betweenactive RF heating and passive conductive heating to maintain a targettemperature level. In various embodiments, the PTC pad 1606 isengineered to exhibit a dramatically increasing resistance above aspecific temperature of the material. The energy delivery electrode 1604is applied internally to the patient's body. A grounding pad appliedexternally to the patient's body completes the circuit. The PTC material1606 will “trip” and become resistive or non-conductive once a selectedtrip temperature is exceeded. As can be seen in FIG. 35, the flexiblenature of the end effector components enables the end effector tosomewhat conform to irregular tissue “T”. These various embodiments maybe employed to treat tissues, such as, for example, liver tissue, lungtissue cardiac tissue, prostate tissue breast tissue vascular tissue,etc. by the application of radio frequencies thereto. The device can beconstructed for laparoscopic or open procedures. The flexible endeffector can be designed to allow access through an access port such asa trocar. Further, the end effector can effectively apply controlledenergy to the tissue. The term “controlled” refers to the ability toprovide current/power to targeted tissue at a predetermined criticaltemperature level. This may be accomplished when the RF energy isapplied to the tissue reaches the point in time that the PTC material isheated to is selected switching range. Thereafter, current flow from theconductive electrode through the flexible engagement surface may beterminated due to the exponential increase in the resistance of the PTCto provide instant and automatic reduction of RF energy. Thus, theflexible end effector can automatically modulate the application ofenergy to tissue between active RF heating and passive conduct heatingto maintain a target temperature level.

FIGS. 36 and 37 depict another end effector 1600′ that is similar to endeffector 1600 described above except for the differences noted below. Ascan be seen in FIG. 36, the elongate shaft 106 is attached to a yoke109. The elongate shaft 106 may be fabricated from an insulator materialsuch as Ultem®, Vectra, etc. or a conductive material such as stainlesssteel. In other embodiments, for example, the elongate shaft 106 may befabricated from a polyolefin heat shrunk tube. Yoke 109 may befabricated from an elastomer such as, for example, polyurethane or ashrink material such as a polyolefin, polyvinylchloride (PVC) orNeoprene. Yoke 109 is pivotally attached to a rigid pad portion 1620that may be fabricated from, for example, polycarbonate or a highdurometer silicone elastomer. The rigid pad portion 1620 is attached toa flexible pad portion 1622 by, for example, an elastomeric adhesive orovermolding process. Flexible pad portion 1622 may be fabricated frompolyisoprene or silicone. The flexible pad portion 1622 may also befabricated from closed or open cell Neoprene or silicone foam. In theembodiment depicted in FIG. 36, two (conductive) made from stainlesssteel, copper, etc.) electrodes 1630 are attached to the flexible padportion 1622 by, for example, an elastomeric adhesive and are attachedto the controller and source of RF energy by cables that extend throughthe elongate shaft 106 and handle. In one non-limiting embodiment, thetwo electrodes 1630 may serve as the source and return of the electricalcircuit, as in a bipolar instrument. In another non-limiting embodiment,the two electrodes may be electrically connected and serve as a singlesource with an external patient return as in a monopolar instrument. Inother embodiments, a single conductive electrode which may besubstantially coextensive with the flexible pad portion may be employed.A flexible PTC member 1640 may be attached to the electrode(s) 1630 by,for example, adhesive or mechanically attached. This embodiment may beoperated in the manner described above.

The devices disclosed herein may be designed to be disposed of after asingle use, or they may be designed to be used multiple times. In eithercase, however, the device may be reconditioned for reuse after at leastone use. Reconditioning may include a combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicemay be disassembled, and any number of particular pieces or parts of thedevice may be selectively replaced or removed in any combination. Uponcleaning and/or replacement of particular parts, the device may bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Those ofordinary skill in the art will appreciate that the reconditioning of adevice may utilize a variety of different techniques for disassembly,cleaning/replacement, and reassembly. Use of such techniques, and theresulting reconditioned device, are all within the scope of thisapplication.

Preferably, the various embodiments of the devices described herein willbe processed before surgery. First, a new or used instrument is obtainedand if necessary cleaned. The instrument can then be sterilized. In onesterilization technique, the instrument is placed in a closed and sealedcontainer, such as a plastic or TYVEK® bag. The container and instrumentare then placed in a field of radiation that can penetrate thecontainer, such as gamma radiation, x-rays, or high-energy electrons.The radiation kills bacteria on the instrument and in the container. Thesterilized instrument can then be stored in the sterile container. Thesealed container keeps the instrument sterile until it is opened in themedical facility. Other sterilization techniques can be done by anynumber of ways known to those skilled in the art including beta or gammaradiation, ethylene oxide, and/or steam.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

1-21. (canceled)
 22. A surgical instrument comprising: a shaft having a proximal end and a distal end; a wrist coupled to the distal end of the shaft and configured to articulate in multiple degrees of freedom; and an end effector supported by the wrist, wherein the end effector comprises a cutting element and jaws configured to grip tissue and fuse tissue, and wherein the cutting element is configured to translate along a longitudinal direction of the jaws.
 23. The surgical instrument of claim 22, further comprising a cutting element drive component configured to translate the cutting element.
 24. The surgical instrument of claim 23, wherein the cutting element drive component is flexible.
 25. The surgical instrument of claim 24, wherein the cutting element drive component is flexible in multiple degrees of freedom about a longitudinal axis of the drive component.
 26. The surgical instrument of claim 23, wherein the cutting element drive component comprises a superelastic material.
 27. The surgical instrument of claim 23, wherein the cutting element drive component comprises an I-beam member.
 28. The surgical instrument of claim 23, wherein the cutting element comprises a cutting blade attached to a distal end of the cutting element drive component.
 29. The surgical instrument of claim 28, wherein the cutting blade is housed within the end effector during translation of the cutting element.
 30. The surgical instrument of claim 22, wherein the end effector further comprises opposing jaws configured in a closed position to grip tissue with a sufficient pressure to permit fusing of the tissue during delivery of energy to the tissue.
 31. The surgical instrument of claim 22, further comprising electrodes for delivery of energy to fuse tissue, the electrodes being respectively associated with the opposing jaws.
 32. The surgical instrument of claim 31, further comprising teeth configured to grip the tissue.
 33. The surgical instrument of claim 31, wherein the energy comprises bipolar electrical energy.
 34. The surgical instrument of claim 22, further comprising a torque drive component configured to transmit torque to move the opposing jaws between open and closed positions.
 35. The surgical instrument of claim 22, wherein the shaft, wrist, and end effector are configured to roll about a longitudinal axis of the shaft.
 36. A method of operating a surgical instrument, the method comprising: receiving at least one first input at a transmission mechanism disposed at a proximal portion of the surgical instrument to articulate a multiple degree-of-freedom articulable wrist of the surgical instrument in at least one of pitch and yaw; transmitting one or more forces via the transmission mechanism to articulate the wrist in response to the first input; receiving a second input at the transmission mechanism to open jaws of an end effector supported by the wrist; transmitting torque via the transmission mechanism to close the jaws of the end effector; receiving a third input at the transmission mechanism to close the jaws of the end effector; transmitting torque via the transmission mechanism to the torque drive component to close the jaws to grip tissue between the jaws; transmitting energy to the jaws to fuse the gripped tissue; receiving a fourth input at the transmission mechanism to translate a cutting element of the end effector; and transmitting a force to a cutting element drive component via the transmission mechanism to translate the cutting element along a longitudinal direction of the jaws of the end effector.
 37. The method of claim 36, wherein transmitting the force to the cutting element drive component comprises translating a push force followed by a pull force.
 38. The method of claim 36, wherein transmitting the force to the cutting element drive component to translate the cutting element occurs while the wrist is articulated in at least one of pitch and yaw relative to a longitudinal axis of a shaft of the surgical instrument to which the wrist is coupled.
 39. The method of claim 36, wherein transmitting the one or more forces via the transmission mechanism to articulate the wrist comprises transmitting one or more forces via the transmission mechanism to exert tension in tendons associated with the wrist. 